Many factors can cause confusion and pyrexia. However, confusion and/or pyrexia in the absence of bowel sounds suggests that they are due to atropine toxicity and will respond to a reduction in the rate of atropine administration.
Alcohol withdrawal, requiring benzodiazepine therapy, must be considered in poisoned patients who are confused.
Control pyrexia as soon as possible; conditions causing pyrexia include agitation from alcohol withdrawal or atropine toxicity, atropine-induced failure to sweat, and high ambient temperature. Active cooling of the patient with fan and water-soaked towels must be a priority because they are at risk of hyperthermia-induced cardiac arrest. Most ill patients will be catheterised after resuscitation to observe urinary output. Urinary retention can therefore not then be used as a marker of toxicity.